The 7-year loss history below is associated with the subject and information listed in the Search Request section of this report. Additional loss history information may be available if additional search information is provided.

CLAIM 1

Claim Date/Age:

06 / 05 / 2006
(03yr - 11mo)

CLUE File #:

1234567890123456

Company:

GROUP INSURANCE INC

Claim #:

1234567

Policy #:

ABCD1234567890

Policy Type:

PERSONAL AUTO

Policy Holder:

DOE
, JAMES
W

Vehicle Operator:

DOE
, JANE

Date of Birth:

11 / XX / 19XX

SSN:

XXX-XX-XXXX

Sex:

M

Address:

12345
PLEASANTDALE RD
ATLANTA,
GA
30303

Drivers License #:

12345XXXX GA

Vehicle:

JEEP LBRTYSPFRD

VIN:

1A2B3C4D5E6F7G8H9

Disposition:

N/A

PAYMENTS BY CLAIM TYPE

Amount

Type

Status

$0

COLLISION

CLOSED

$710

PHYSICAL/PROPERTY DAMAGE

CLOSED

$0

RENTAL REIMBURSEMENT

CLOSED

Additional Info:

N/A

POSSIBLE RELATED CLAIMS

Claims listed below are based on a match of the subject's last name and the address(es) listed in the Search Request section of this report.

CLAIM 1

Claim Date/Age:

06 / 05 / 2003
(06yr - 11mo)

CLUE File #:

1234567890123456

Company:

GROUP INSURANCE INC

Claim #:

7654321

Policy #:

ABCD1234567890

Policy Type:

PERSONAL AUTO

Policy Holder:

DOE
, JAMES
W

Vehicle Operator:

DOE
, JANE

Date of Birth:

11 / XX / 19XX

SSN:

XXX-XX-XXXX

Sex:

M

Address:

12345
PLEASANTDALE RD
ATLANTA,
GA
30303

Drivers License #:

12345XXXX GA

Vehicle:

JEEP LBRTYSPFRD

VIN:

1A2B3C4D5E6F7G8H9

Disposition:

N/A

PAYMENTS BY CLAIM TYPE

Amount

Type

Status

$7,000

COLLISION

CLOSED

$50

RENTAL REIMBURSEMENT

CLOSED

Additional Info:

N/A

INQUIRY HISTORY

Date:

11 / 22 / 2009

Requestor:

FACTACT/CHOICEPOINT

Date:

04 / 01 / 2010

Requestor:

FACTACT/CHOICEPOINT

Prepared by:

COMPREHENSIVE LOSS UNDERWRITING EXCHANGE
C.L.U.E. Inc., Atlanta, GA.

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